Paediatric Forensic Medicine and Pathology PDF

PREFACE

The possibility that a child may have been injured, abused, neglected or otherwise ill treated rightly raises the indignation and anxiety of the caring professions and involves law enforcement agencies. However, in the interests of justice and fairness, a person accused of such injury or neglect is entitled to appropriate legal representation at any hearing and is deemed to be innocent until proven guilty. Quite frequently, dubiety and uncertainty linger about whether or not, in any specific situation, observations made, clinically or pathologically, can be interpreted solely as a manifestation of inflicted injury or neglect, or whether there is a possibility that the observed findings could have come about in other, noncriminal, circumstances. These matters necessitate advice from those with experience and expertise in this field.

The aim of this book is to furnish an authoritative, comprehensive text to assist practitioners of medicine and the law dealing with such cases in the appropriate interpretation of these matters and to enable clinical and pathological findings to be presented in an unbiased and dispassionate manner so that the courts are able to better evaluate the specialist evidence put before them.

The investigation and interpretation of findings of alleged ill treatment of infants and children requires a multidisciplinary approach, centred on the child, his or her well-being in both the short term and longer term, as well as that of any siblings within the same environment. All of the available information about any incident must be carefully collected, collated and evaluated. Laboratory data, both clinical and forensic, the results of radiological investigations and information from the examination of the scene where any incident took place should be carefully sought and evaluated against the clinical findings. A team approach is essential, with close collaboration of family physicians, paediatricians involved in both community and hospital practice, the clinical forensic medical examiner and specialist pathologists, together with police and social welfare services. No incident should be looked at in isolation but rather in the context of the child's development and interaction with his or her family, environment and peer group. The survivors of inflicted injury or neglect in childhood must be carefully followed up, protected and their family unit supported.

In this book, some of the topics covered here are relevant specifically to maltreatment in early life, beginning with the examination of an infant or child for whom abuse is suspected, incorporating the family environment and set against criteria for normal development. The difficult problem of suspected sexual abuse of children is considered separately. The extensive clinical experience of the authors of the opening chapters is readily apparent, highlighting, as they do, the pitfalls of incomplete investigation and illconsidered interpretation. The appropriate level of investigation of specific findings, interpretation of investigations and consideration of differential diagnoses are addressed in chapters contributed by a paediatric radiologist, a haematologist and a clinical pathologist, respectively. Those areas requiring specialist clinical expertise and experience – the eyes, mouth and central nervous system – are considered by specialists in those fields with extensive paediatric experience. The examination of the scene of death or injury is discussed as a background to post-mortem examination of the very young. The interpretation of cerebral pathology in the newborn, the investigation of sudden or suspicious perinatal death and sudden death in both infants and older children are addressed by experienced practitioners. Separate consideration is given to sudden or suspicious deaths that occur in hospital.

In subsequent chapters, more general areas of forensic pathology, including asphyxia and thermal injury, drowning, injury to road users and other accidents are addressed from a paediatric viewpoint. A similar approach is evident in the chapters covering toxicological investigation, DNA profiling and dental identification.

The book concludes with consideration of the role of the expert witness in criminal judicial cases and the provision of reports in the civil medicolegal context.

Although the majority of contributors to this text are UK based, the subject matter is presented, as far as possible, without national or geographic bias, so that the contents have international relevance.